title: Pathologic investigation failure of trabeculotomy.
abstract: OBJECTIVE
  To investigate the reason for failure of trabeculotomy using trabeculectomy (TLE) specimens involving the area of previous trabeculotomy.
  
  
  METHODS
  Thirteen TLE specimens from 13 patients with open-angle glaucoma were processed for transmission electron microscopy and light microscopy, involving immunohistochemical staining of thrombomodulin, D2-40 (podoplanin), and CD34.
  
  
  RESULTS
  All intraocular pressure after trabeculotomy decreased to normal and then returned to the same or a higher level compared with that before TLE. Eleven and 2 TLE specimens were taken from areas with no peripheral anterior synechia (PAS) and PAS areas, respectively. The 4 types of histologic change in the trabecular meshwork were observed: (1) persistence of a disconnected trabecular meshwork with swelling or degeneration at the cut edge; (2) fusion of the trabecular meshwork; (3) a membrane covering the innermost trabecular meshwork; and (4) pigmented cell invasion into the disconnected trabecular meshwork at the PAS site. Schlemm canal (SC) opening into the anterior chamber and SC occlusion were observed in 2 and 8 eyes, respectively.
  
  
  CONCLUSIONS
  Opening of SC into the anterior chamber observed in the eyes with failed trabeculotomy suggested that the enhancement of conventional routes may not be important for the intraocular pressure-lowering effect. All 4 types of histologic change in the trabecular meshwork, as mentioned above, may reduce enhancement of the newly created unconventional routes by trabeculotomy.
authors.affiliation: *Department of Ophthalmology, Japanese Red Cross Medical Center, Tokyo †Hikuma Eye Clinic, Kumamoto, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Amari
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Hamanaka
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Futa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology; D018952:Antigens, CD34 / Q000378:metabolism; D017889:Exfoliation Syndrome / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D018180:Thrombomodulin / Q000378:metabolism; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000378:metabolism / Q000648:ultrastructure*; D014130:Trabeculectomy; D017211:Treatment Failure; D055815:Young Adult; D000098853:Podoplanin
chemical_list: D018952:Antigens, CD34; D008562:Membrane Glycoproteins; D018180:Thrombomodulin; C117468:PDPN protein, human; D000098853:Podoplanin; C546931:THBD protein, human